Meter Swap � Request Number: 12411
Public Works Division
Service Request
Problem Address: 7529 Jackson St Requested By: Mr Mortenson
Deputment: WA'IER Arldress: No address provided
ProWem/Iss�: INSTALL AMR METER Phone Number: 763-7$4-4244
Schednled D'te: 2016-12-15 Schedaled Ttme: 10:30:00
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ACIiON NEEDED:AMR
Crested by: Wendy Histt Date Crerted: 2016-12•09
ACTION TAKCN: �
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Stat�: In Progess Snbmitter H�Bcee r
CoMacted
D�te ComQleted: 1 Z— )� - ,� Completsd by:
CiY,�-��,�'7�'��..._
City of Fridley
Water Department `�� �� ,� �
6431 University.Avenue NE l
, Fridley,MN 55432 �-�����3�j �jf
763-572-3566 ,�� �
I/we �M r �'`��ti������-`i� hereby authorize the City of Fridley and/or its employees to do what is necessary to
replace the water meter. I understand that the property owner is tiabie for the water line from the main to the premise and aii irrterior
plumbing. (Per City code 402.06) 1 also hold the C'tty of Fridley and/its employees harmless for any damages that may occur while doing this
operation. This to include,but not limited to valves,piping,walls,fl�rs or the curb stop box and service line. In understand I am also required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter) v L l9 � � v�
Name• � �`�f�v"�u^ Address_ � � � l L CtiL'�5fi'� �i�
Phone Number �CP� ''� ��"���� �2'���j"���Q
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�.Signature j��-v c•.r ........__._� Witness Signature ' �""'� U`�'v`-�"_—"""...,.. ..
,., (����,M/�,v�,�o`-P#a�.�..�oz��'SA-I- �
OLD METER# L� �� �� ' �✓�-
OLD READIN6 b �� ` � w
NEW METER# �''I� � I (J� �S
NEW READING �
ERT# � �8� �_ I � �
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANtTARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191�
402.5 PERMIT FEE
Prior to constructing or repair of any wate�of sewer tine connecting the existing municipal system and arry house or buiWtr�for which the
appiication is made,the owner or contractor shail be required to obtain a permit for such connection,and shall pay a permit fee as�ded in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be notified. it shall be unlawful to�ver
any connecting line until an inspection has been made and such connection and the wor�c inddent thereto has been approved by the Gty as a
proper and suitable connection.
402.06 REPAIRS AND MAINTENANCE TO CONNEC770N
After the initial connection has been made to the water service curb stop box or the sewer lead at the property Iine or a water seMc�e lead has
been extended to the property line for connection,the applicaM,owner,or occupaM or user of wch premises shall be liable for all repatrs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property ow�er
requests mai�rtenance service or repairs be performed by the City,the property owner shall be charged for the costs of the mairitenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shall be the r�sponsibii€ty of the applicarrt,
owner,occupant or user to perform standard maintenance of the sewer service tine from the premises to the main inctuding debris dearir�g or
root cutting and to maintain the water service curb stop box for operability and at wch height as will ensure that it remains above the fnished
grade of the land or property. (Ref 638,1156,1191)
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City of Fridley
water Department
Address ���� ,,��cl�sU ✓J
Name �t�vl �jv/���c ,�,�
Date ��� � -c> �
Old Meter Number c�
Old Meter Reading ��. (� ��G�
Replacement No. c-c� �~ /�g ,��,�J�
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Replacement Make �—� �
Rem :_�GIG'!�S"r'r'J' 1�0�!l �lG 7'�''��.
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, S igned +' ��/
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